The 2010, the NSW Health maternity care policy, Towards Normal Birth in NSW was developed in response to the Mothers and Babies Report 2006* which revealed that both elective and emergency caesarean section operations in NSW hospitals had increased by about 10%. With evidence of increased maternal mortality and morbidity associated with multiple caesarean operations, the focus of that policy was to reduce caesarean section operation rates.
The Towards Normal Birth policy was due for review by the NSW Ministry of Health in 2018. This review commenced in early 2018 with review of the literature and evidence and then a large online consumer survey. More recently a series of face-to-face workshops have taken place around the state with key stakeholders and will be followed up with focus groups. Once concluded, the Ministry will consolidate the material and draft a policy, with invitations for written submissions planned for July/August 2019. It is expected that the final policy will be released in late 2019.
Framework and companion policies
Although maternity services are delivered at a state level through public and private services, there is a national framework for the strategic direction of Australian maternity services. The overarching framework encompasses four values and principles: respect, access, choice, and safety. This national framework therefore informs the revision of the NSW Health maternity care policy.
Additionally, the new NSW policy is being developed as a companion document to the NSW Health First 2000 Days Framework. This framework provides an evidence-based platform for the NSW Health sector to support children and their families to lead healthy and fulfilling lives. It recognises the importance of the first 2000 days of a child’s life, from conception to age 5.
Maternity care and improved health outcomes
The review of the evidence has identified ten key principles or aspects of care which are important for the improvement of health outcomes for mothers, babies and families. These are:
- Women and families receive maternity care that is socially and culturally respectful.
- Women’s views are actively used to improve their care and services.
- Women are offered appropriate choices in how their maternity care is provided.
- Care plans reflect the individual needs of women, babies and families.
- Different care options are clearly explained and women and their partners are actively involved in the decision-making about their care.
- Pregnant women are able to access care early and regularly.
- Women and families who have additional needs are referred to appropriate services.
- People are able to access the care and support they need to care for their baby and themselves after birth.
- People who are planning a pregnancy or are pregnant feel able to make fully informed decisions about all aspects of their care.
- Women are informed of the risks and implications of all aspects of their care during labour and birth, and receive safe, high-quality, evidence-based care that is appropriate to their individual needs and expectations.
The ten principles above, if enshrined in the new policy, will be an improvement on the preceding policy, Towards Normal Birth in NSW. The previous maternity care policy had a clinical focus to promote an increase in the proportion of natural vaginal births (considered “normal”); in other words, to decrease labour interventions such as induction, epidural, forceps or ventouse extraction, episiotomy and caesarean. This is problematic for many reasons but one important reason is that it focuses on a particular clinical approach or outcome, rather than the needs and safety of the individual. A policy based on this, by its very nature, creates pressure and propels both clinicians and expectant mothers towards one method of birth which may or may not be appropriate in her individual circumstances.
It is hoped that the new policy will represent a move away from this focus and instead turn its attention to promoting and providing maternal care that is driven by the individual needs and circumstances of the mother and her family, regardless of her social, economic, or cultural background.
*Centre for Epidemiology and Research, NSW Department of Health New South Wales Mothers and Babies, 2006, NSW Public Health Bulletin 2007.